Provider Demographics
NPI:1740900273
Name:D'ALENCAR, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:D'ALENCAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 10TH ST E UNIT 2403
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2250
Mailing Address - Country:US
Mailing Address - Phone:339-368-4728
Mailing Address - Fax:
Practice Address - Street 1:78 10TH ST E UNIT 2403
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2250
Practice Address - Country:US
Practice Address - Phone:339-368-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125744183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist